Tilburg University
Do dissatisfied patients have unrealistic expectations?
Hafkamp, Frederique J; Gosens, Taco; de Vries, Jolanda; den Oudsten, Brenda L
Published in:
EFORT Open Reviews
DOI:
10.1302/2058-5241.5.190015
Publication date:
2020
Document Version
Publisher's PDF, also known as Version of record Link to publication in Tilburg University Research Portal
Citation for published version (APA):
Hafkamp, F. J., Gosens, T., de Vries, J., & den Oudsten, B. L. (2020). Do dissatisfied patients have unrealistic expectations? A systematic review and best-evidence synthesis in knee and hip arthroplasty patients. EFORT Open Reviews, 5(4), 226-240. https://doi.org/10.1302/2058-5241.5.190015
General rights
Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain
• You may freely distribute the URL identifying the publication in the public portal Take down policy
EOR|volume 5|April 2020 DOI: 10.1302/2058-5241.5.190015 www.efortopenreviews.org
End-stage osteoarthritis is commonly treated with joint replacement. Despite high clinical success rates, up to 28% of patients are dissatisfied with the outcome.
This best-evidence synthesis aimed to review studies with different forms of study design and methodology that examined the relationship between (fulfilment of) out-come expectations of hip and knee patients and satisfac-tion with outcome.
A literature search was performed in PubMed, Web of Sci-ence, PsycInfo, Cochrane, and Google Scholar to identify studies conducted up to November 2017. The method-ological quality of studies was assessed using the Newcastle-Ottawa Scale.
In this best-evidence synthesis systematic review, the following main results could be seen. In only half of all studies were preoperative expectations associated with level of satisfaction, while in almost all studies (93%), fulfilment of expectations was related to satisfaction. The effect of met expectations did not differ between hip and knee patients or study design.
Fulfilment of expectations seems to be consistently asso-ciated with patient satisfaction with outcome. Emphasis in future research must be placed on the operational-ization and measurement of expectations and satisfac-tion to determine the (strength of the) influence of these different forms of assessment on the (existence of the) relationship.
Keywords: expectations; fulfilment; PROMS; satisfaction; THA; TKA
Cite this article: EFORT Open Rev 2020;5:226-240. DOI: 10.1302/2058-5241.5.190015
Introduction
Osteoarthritis (OA) is the most common chronic joint dis-ease, leading to limitations in activities of daily living (ADL).1–3 Joint replacement is a commonly used treatment
in orthopaedics for end-stage OA.4–9 The risk of
complica-tions with joint replacement is usually low and clinical success rates are high.6,7,9 Up to 90% of patients improve
in function after the replacement of the affected joint.5
However, up to 30% of all patients report some degree of dissatisfaction with the results of the replacement of the knee (i.e. total knee arthroplasty; TKA) or hip (i.e. total hip arthroplasty; THA).4,10–14
Dissatisfaction with the results of surgery could concern, for example, dissatisfaction with improvement in pain or function resulting from medical interventions.15
Dissatisfac-tion with these outcomes has been found to result in non-adherence with medication and advice and delayed or insufficient physical improvement.16,17 This type of
dissatis-faction is commonly examined with the reliable and vali-dated self-administered Patient Satisfaction Scale,18 and
thereby refers to overall satisfaction with surgery, with pain relief, and with the ability to perform work and recreational activities.19–22 Some studies have indicated that low
satisfac-tion with outcomes of treatment might be related to high preoperative expectations,23,24 as it is found that patients
commonly have very optimistic expectations about the results of surgery.23–26 Nonetheless, other studies reported
no relationship between preoperative expectations and patient satisfaction,21,24,27 and some found that fulfilment
of these expectations, rather than expectations themselves, could lead to satisfaction.13,22,25,26 In fact, fulfilment of
expectations was the most important factor linked with post-surgery satisfaction in several studies.22,25,28
Do dissatisfied patients have unrealistic expectations?
A systematic review and best-evidence synthesis in
knee and hip arthroplasty patients
Frederique J. Hafkamp
1,2Taco Gosens
3Jolanda de Vries
1,2,4Brenda L. den Oudsten
1,25.1900EOR0010.1302/2058-5241.5.190015
review-article2020
Patients’ outcome expectations particularly concern a belief or anticipation that certain actions (i.e. surgery)
will achieve particular outcomes.29–31 Postoperative
ful-filled expectations, however, concern a consideration of whether surgery did achieve particular outcomes, that is, whether expectations have been met.32 Although these
concepts are clearly defined, assessment of these outcome expectations could focus on all different kinds of out-comes, such as, for example, general improvement,10,33–35
or more specific pain level,36–38 or functioning.26,36,38 The
Hospital for Special Surgery Hip (Fulfilment) Replacement Expectations Survey (HSS-H(F)RES)33 or the Hospital for
Special Surgery Knee (Fulfilment) Replacement Expecta-tions Survey (HSS-K(F)RES)39 are questionnaires
com-monly used to assess (fulfilled) expectations in THA and TKA patients, as they examine a broad range of possible outcomes on a continuous scale (i.e. the level of satisfac-tion) rather than a binary scale (i.e. expectations yes/ no).20,25,32,40,41
Based on the literature, it is still not clear whether pre-operative expectations or the level of fulfilled expectations are related to patient satisfaction with outcome after sur-gery. This may be due to differences in methodology. For instance, studies varied in the operationalization (i.e. the precise description of a concept to make it measurable, using, for example, questionnaires) of patients’ outcome expectations and satisfaction with outcome. In addition, conflicted findings could have resulted from differences in study design. Specifically, while multiple studies found no relationship between preoperative expectations and satis-faction,36,38,42 when examining it prospectively, one known
study reported a relationship between expectations and satisfaction when examining preoperative expectations retrospectively.33 Differences in study design might explain
the relationship between postoperative expectations and satisfaction, as patients’ recall of expectations might have changed due to the surgery and recovery process.43,44
Moreover, emphasis in research is predominantly placed on TKA patients instead of THA patients.11,22,26,44 Yet,
satis-faction in THA patients could be low and determined by (fulfilment of) expectations as well.4,8 Furthermore, few
studies have examined (differences in) satisfaction and effects of expectations between TKA and THA patients, although there might be a variation in short-term and long-term satisfaction between these patient groups. For example, THA patients are often more satisfied and usually recover faster and to a larger extent than TKA patients,4,8,45
even though function seems to return to the same level for both patient groups after six months.4
Several previously published systematic reviews have examined the relationship between preoperative expecta-tions and satisfaction in orthopaedic patients.31,44,46–49
Nonetheless, most of the systematic reviews did not include all relevant studies,31,46,49 and they rarely focused
on fulfilment of these expectations,44,47,48 or only on the
relationship in TKA patients and not in THA patients.31,47
Moreover, only one single systematic review examined the influence of differences in methodology.49 This study
therefore aims to systematically review all studies that have been performed on the relationship between (fulfilment of) expectations and satisfaction with outcome in TKA and THA patients, in order to determine what connection (ful-filled) expectations and satisfaction with outcome have in these patient groups. A best-evidence synthesis will be used and recommendations for future research and impli-cations for clinical practice will be made.
Materials and methods
In accordance with the PRISMA guidelines, this systematic review protocol was registered with the International Pro-spective Register of Systematic Reviews (PROSPERO) on 10 February 2017 (registration number: CRD42017052851).
Search strategy
An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane, and Google Scholar to identify eligible studies published in English or Dutch up to the end of October 2017. Search terms were developed using MeSH terms and consisted of text words related to (1) knee arthroplasty and/or hip arthroplasty, (2) expecta-tions or expectancies, and (3) satisfaction (Table 1). The terms ‘expectations’ and ‘expectancies’ are both used in the literature to indicate that someone is ‘expecting some-thing for the future’. As Haanstra et al stated, expectancies could be defined as ‘the act or state of expecting’ and expectations as ‘cognitions regarding probable future events’.31 Although different concepts, the existing
litera-ture was followed and no distinction was made between these two terms.
Eligibility criteria
TKA and/or THA patients were available in the study. OA is the most common indication for a total knee or hip replace-ment. However, studies including other conditions (e.g. avascular necrosis or rheumatoid arthritis) leading to TKA or THA were also included, as we were interested in the effects of TKA and THA and not of the underlying disease. Studies examining patients with revision TKA or THA were also included, as the aim of the study was not to examine levels of expectations (which could have been different in revision surgery), but to examine the relationship between expectations and satisfaction.
If a study examined TKA and/or THA patients in combi-nation with other patient groups, yet did not report data on the different patient groups, the study was excluded, as we would otherwise be unable to make a distinction between the differences in patient groups. In line with the aims of our study, we chose to examine only studies that assessed satisfaction with outcome, and therefore excluded studies examining, for example, satisfaction with care, satisfaction with received information, and sat-isfaction with treatment choice. In addition, we chose to only examine studies which assessed outcome expecta-tions, and not, for example, self-efficacy beliefs, or expec-tations about the process of treatment.29,31 Even though
outcome expectations and satisfaction with outcome could be operationalized in different ways, we chose to include all studies that examined these concepts, regard-less of the operationalization of these concepts.
Data extraction
Data were extracted from the included studies using a standardized extraction form (Table 2). If multiple articles had been written on the same dataset, only the most recent study was included. When a study included both TKA and THA patients, a comparison was made between these different patient groups. If no data on the different groups were available, authors were contacted to ask whether they had data on the different subgroups and, if so, to forward it. In addition, comparisons were also made between studies examining preoperative expectations with a retrospective and with a prospective design.
Quality assessment
The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses was used to assess the methodological quality of studies.50
The NOS assesses studies on three different constructs (selection, comparability and exposure/outcome), with
Table 1. Search strategy for each database.
Database Search terms Date of search 2nd date of search 3rd date of search PubMed ((((((((((((((“tka") OR "tha") OR "total knee arthroplasty") OR "total hip
arthroplasty") OR "hip replacement") OR "knee replacement") OR "tkr") OR "thr") OR "joint replacement") OR "joint prosthesis") OR "knee prosthesis") OR "hip prosthesis")) AND ((("pre operative expectations") OR "post operative expectations") OR "expectations")) AND (("satisfaction") OR "satisfied")
3-10-2016 10-4-2017 30-10-2017
Cochrane
library #1 "TKA":ti,ab,kw or "THA":ti,ab,kw or "total knee arthroplasty":ti,ab,kw or "total hip arthroplasty":ti,ab,kw #2 joint prosthesis:ti,ab,kw or knee prosthesis:ti,ab,kw or hip prosthesis:ti,ab,kw #3 hip replacement:ti,ab,kw or knee replacement:ti,ab,kw or joint
replacement:ti,ab,kw #4 expectations:ti,ab,kw or expectancies:ti,ab,kw #5 satisfaction:ti,ab,kw or satisfied:ti,ab,kw #6: #1 or #2 or #3 and #4 and #5 3-10-2016 10-4-2017 30-10-2017 Google
Scholar expectations AND satisfaction THA OR TKA OR "Total knee arthroplasty" OR "total hip arthroplasty" OR "joint prosthesis" OR "knee prosthesis" OR "hip prosthesis" OR "hip replacement" OR "knee replacement" OR "joint replacement"
3-10-2016 10-4-2017 30-10-2017
Web of
Science #1: TS=(tka) OR TS=(tha) OR TS=(total knee arthroplasty) OR TS=(total hip arthroplasty) OR TS=(hip replacement) OR TS=(knee replacement) OR TS=(tkr) OR TS=(thr) OR TS=(joint replacement) OR TS=(joint prosthesis) OR TS=(knee prosthesis) OR TS=(hip prosthesis)
Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, BKCI-S, BKCI-SSH, ESCI Timespan=All years
#2: TS=(pre operative expectations) OR TS=(post operative expectations) OR TS=(expectations) OR TS=(expectancies)
Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, BKCI-S, BKCI-SSH, ESCI Timespan=All years
#3: TS=(satisfaction) OR TS=(satisfied) OR TS=(dissatisfaction) OR TS=(dissatisfied) OR TS=(satisfy*) OR TS=(dissatisfy*)
#4: #1 AND #2 AND #3
3-10-2016 10-4-2017 30-10-2017
PsycInfo AB ( tka OR tha OR total knee arthroplasty OR total hip arthroplasty OR hip replacement OR knee replacement OR tkr OR thr OR joint replacement OR joint prosthesis OR knee prosthesis OR hip prosthesis ) AND AB ( pre operative expectations OR post operative expectations OR expectations OR expectancies ) AND AB ( satisfaction OR satisfied OR dissatisfaction OR dissatisfied OR satisf* OR dissatisf*
eight questions on which studies could score a maximum of nine points in total (i.e., four points for selection, two points for comparability and three points for exposure/ outcome) . Studies with a score of six or more points on the NOS were regarded as qualitatively good.51 In order
to assure objective assessment, the quality assessment was independently conducted by two researchers. In case of disagreement between reviewers, points of disa-greement were discussed in order to reach consensus.
Statistical analysis
A comparison was made between TKA and THA patients in terms of fulfilled expectations and satisfaction. All studies were compared based on average percentages of fulfilled expectations or as percentages of patients who were satisfied, or had all their expectations fulfilled, cal-culated as a weighted average across all studies examin-ing respectively TKA or THA patients. The number of participants in studies with no separated data on TKA and THA patients were equally split between TKA and THA patients.
Data synthesis
Due to study heterogeneity, it was impossible to synthe-size the data in a analysis. An alternative to meta-analysis is the best-evidence synthesis, in which studies are classified based on level of internal and external valid-ity.51 Studies were identified as ‘strong/high quality’ when
receiving 6 to 9 points on the NOS. Studies were identi-fied as moderate quality or weak quality when receiving respectively 4 or 5, or 1 to 3 points.51
Studies were classified as either reporting a significant relationship between (fulfilment of) expectations and satisfaction or as reporting no significant relationship between these concepts based on their own findings and conclusions. Statistical values were, when reported, included in our systematic review. The levels of evidence regarding the significance or non-significance of a rela-tionship among studies were ranked according to the following statements: (1) strong evidence: consistent findings (> 75% of the studies reported consistent find-ings) in multiple high-quality studies; (2) moderate evi-dence: consistent findings (> 75% of the studies reported
Reference lists of included articles (N=86) Records after deduplication (N=20) References search References search Identification Screening Eligiblity Inclusion PubMed
(N=196) Web of Science(N=319) PsycInfo(N=11)
Records after deduplication
(N=401) Excluded (N=315)
• Did not include ‘expectations’ (N=77) • Did not include ‘satisfaction’ (N=45) • Did not compare ‘expectations’ and ‘satisfaction’ (N=122)
• No TKA and/or THA (N=23) • No data (N=3)
• Review article (N=32) • No abstract (N=4) • No full text available (N=11)
Excluded (N=82)
• Did not include ‘expectations’ (N=12) • Did not include ‘satisfaction’ (N=13) • Did not compare ‘expectations’ and ‘satisfaction’ (N=30)
• No TKA and/or THA (N=9) • No data (N=12) • Review article (N=5) • No full text available (N=1) Full-text articles assessed (N=104) Included (N=22) Cochrane (N=21) Google Scholar(N=39) Reference list of reviews (N=14)
Fig. 1 Flowchart of study selection.
Table 2. Characteristics of included studies.
Author, year TKA/
THA N Follow-up Age Operationalization of expectations Study design/ measurement level
% fulfilled % patients with fulfilled expectations
Operationalization
of satisfaction Measurement level % satisfied patients Anakwe et al,
201112 TKA 850 1 yr 68 One question about fulfilment of
expectations, n.s.
4-point Likert
scale n/a n/a One question concerning satisfaction with the results of surgery. Additionally: a rating of the pain relief that is achieved, a rating of the success of operation in performance on heavy lifting, the likelihood of recommendation of the operation to a friend, willingness to have operation again, rating of the hospital.
4–5-point
Likert scale 93.0%
Arden et al,
201136 THA 639 2 yrs 68 Preoperative questionnaire with
questions about: expectations for postoperative pain and limitations in usual activities Prospective 3–4-point Likert scale One question about level of satisfaction with the result of the hip replacement. Binary (satisfied vs. dissatisfied) 92.8% Bourne et al,
201011 TKA 1708 1 yr 69 Fulfilment of expectations, n.s.
Additionally: willingness to have surgery again
n.s. n/a n/a Three questions concerning: satisfaction with the results of the knee replacement, satisfaction with pain reduction, and satisfaction with the ability to perform five functions (going up stairs, getting in/out of a car/ bus, rising from bed, lying in bed, performing light domestic duties).
5-point Likert scale 81.0%
Clement
et al, 201540 TKA 322 1 yr 71 Fulfilment of HSS-KFRES39 5-point Likert scale n/a 56% One question about level of satisfaction
with the operated knee.
4-point Likert scale 86.0% Eisler et al,
200237 THA 98 1 yr 70 Two questions about fulfilment of
expectations with future pain, and walking ability
4-point Likert
scale n/a 55–69% A grading of overall satisfaction. 6-point Likert scale 63.0%
Gandhi et al,
200942 TKATHA 1799 1 yr 69–74 Three questions regarding
preoperative
expectations about: time to fully recover, level of postoperative pain, and ability to perform usual activities Prospective Responses collapsed into 3-point Likert scale
One question about level of satisfaction the results of the surgery. Binary (satisfied vs. dissatisfied) 93.0– 95.0% Hamilton
et al, 201310 TKATHA 4709 1 yr 7070 One questions about fulfilment of
expectations, n.s.
6-point Likert
Author, year TKA/
THA N Follow-up Age Operationalization of expectations Study design/ measurement level
% fulfilled % patients with fulfilled expectations
Operationalization
of satisfaction Measurement level % satisfied patients Additionally, questions about: pain relieve after surgery, improvement in ability to perform regular activities, performance of heavy work or sport activities, rating of overall hospital experience, willingness to have operation again, the likelihood of recommendation of the operation to a friend. Jain et al,
201719 THA 207 6 mo 65 Preoperative expectations:
HSS-HRES33 Prospective 5-point Likert scale The Self-Administered Patient Satisfaction Scale.32 4-point Likert scale 94.5% Jain et al,
201720 TKA 83 1 yr 70 Fulfilment of HSS-KFRES39 5-point Likert scale 76.7% n/a The Self-Administered
Patient Satisfaction Scale.32
4-point Likert scale 92.3% Kiran et al,
201538 TKA 365 2 yr 72 Two preoperative questions about
expectations with: limitations in usual activities, pain after recovery Prospective 4-point Likert scale One question concerning satisfaction with the result of the knee replacement. Additionally, three questions regarding: improvement in overall function, reduction of pain, reduction of pain medication. Binary (satisfied vs. dissatisfied) 83.8% Lim et al,
201534 TKATHA 3488 > 2 yr 6761 One question regarding: fulfilment
of patient’s expectations, n.s.
7-point Likert
scale n/an/a 95.6%94.9% Rating of overall results of surgery. 6-point Likert scale 90.5%91.9% Lingard et al,
200621 TKA 525 1 yr 69 Four preoperative questions about
expectations for: pain level, walking distance, limitation of recreational activity, and use of a walking aid Prospective 5-point Likert scale The Self-Administered Patient Satisfaction Scale.32 Additionally, two questions about performance after surgery and willingness to have the same surgery again.
4-point Likert scale n/a
Mancuso
et al, 199733 THA 180 2–3 yr 65 Two preoperative questions about:
expectations of surgery and hopes
Retrospective Open-ended questions Three questions concerning: willingness to have operation again, meeting expectations, overall satisfaction with the results of hip arthroplasty.
Open-ended 89.0%
Mancuso
et al, 200941 THA 405 6 yr 66 Fulfilment of HSS-HFRES33 5-point Likert scale 87% 75% One question: ‘If you were to spend the
rest of your life with your hip symptoms just the way they have been in the last 24 hours, how would you feel?’
7-point Likert scale 94.0%
Table 2 (continued)
Author, year TKA/
THA N Follow-up Age Operationalization of expectations Study design/ measurement level
% fulfilled % patients with fulfilled expectations
Operationalization
of satisfaction Measurement level % satisfied patients Mannion
et al, 200924 TKA 112 2 yr 67 Questions concerning
fulfilment of
expectations about: time to full recovery, pain after recovery, and limitations in everyday activities after recovery
Open-ended,
Likert scale n/a 30% / 47% One question about satisfaction with surgery, n.s.
4-point Likert scale 90.1%
Noble et al,
200626 TKA 253 1 yr 68 One question about fulfilment
of expectation concerning level of activity Binary (fulfilled vs. not fulfilled)
n/a n/a One question about satisfaction with knee replacement. Binary (satisfied vs. dissatisfied) 75.0% Palazzo et al,
201425 THA 132 > 1 yr 64 Fulfilment of HSS-HFRES33 5-point Likert scale 73.1% n/a One question: ‘If you were to spend
the rest of your life with your hip symptoms just the way they have been in the last 24 hours, how would you feel?’
7-point Likert scale 91.9%
Scott et al,
201022 TKA 1141 1 yr 70 One question about fulfilment of
expectations, n.s.
6-point Likert
scale n/a n/a The Self-Administered Patient Satisfaction Scale.32
4–6-point
Likert scale 81.4% Scott et al,
201232 TKATHA 669 1 yr 6971 Fulfilment of HFSS-KRES39
Fulfilment of
HFSS-HRES33
5-point Likert
scale 59%72% 10%21% One question about satisfaction with the operated hip/knee. 4-point Likert scale 78.0%88.0% Gonzalez Saenz de Tejada et al, 201454 TKA
THA 892 1 yr 69 Adapted version of HSS-KRES39
/HSS-HRES33 (preoperative
expectations)
Prospective 5-point Likert scale
One question: ‘If you were to spend the rest of your life with your hip symptoms just the way they have been in the last 24 hours, how would you feel?’
4-point Likert scale n/a
Thambiah
et al, 201528 TKA 103 > 1 yr 64 Questionnaire assessing
preoperative
expectations about: improved mobility, reduced pain and better overall quality of life
Prospective
n.s. One question examining overall patient satisfaction. In addition, two questions about recommendations to others and willingness to undergo surgery again. 5-point Likert scale 92.8% Vissers et al,
201035 TKA 44 6 mo 64 Four questions about fulfilment
of expectations regarding: pain after surgery, limitations of activities of daily living after surgery, the overall success of the operation and likeliness of having complications
4-point Likert
scale n/a n/a One question about satisfaction with results of surgery.
5-point Likert scale 72.7%
Note. TKA, total knee arthroplasty; THA, total hip arthroplasty; K(F)RES, Hospital for Special Surgery Knee (Fulfilment) Replacement Expectations Survey;
HSS-H(F)RES, Hospital for Special Surgery Hip (Fulfilment) Replacement Expectations Survey.
consistent findings) in one high-quality study and two or more moderate-quality studies, or in three or more weak-quality studies, (3) limited evidence: generally consistent findings (> 75% of the studies reported consistent find-ings) in a high-quality study or in two or fewer moderate-quality studies, (4) no evidence: no studies could be found, (5) conflicting evidence: conflicting findings.52
Results
Study selection process
The search resulted in 586 records. After the removal of 185 duplicates, 401 unique studies were screened (see Fig. 1). Based on abstract and title, 315 articles were excluded. The reference lists of included articles and exist-ing relevant reviews were scanned for additional articles. Another 82 articles were excluded after full-text assess-ment, leaving a remaining 22 included articles.
Study characteristics
Twenty (90.9%) cohort studies and two cross-sectional studies26,33 (9.1%) were included in this review (Table 2).
One of the cohort studies was labelled as a cross-sectional study,11 yet this study included multiple follow-up periods
with multiple assessments within the same patients, so we considered it a prospective cohort study. Only one study examined revision surgery, instead of primary TKA or THA.37
Expectations
The operationalization of expectation and satisfaction was quite diverse across studies (see Table 2). However, the majority used the HSS-K(F)RES or HSS-H(F)RES 39,53 or an
adaptation of these scales (seven studies) or assessed ful-filment of expectations with one single question (six stud-ies) (Table 2). Others focused on hopes or expectations regarding, for instance, limitations in daily living, pain and walking ability. Some studies examined the number of expectations patients have,24,33 while others assessed the
level of patients’ expectations,21,38,42 or a combination, in
relationship with satisfaction.19,20,25,32,40,41,54 For example,
scores on the HSS-H(F)RES or HSS-K(F)RES represent the combined amount of (fulfilled) expectations the patient has and the level of these (fulfilled) expectations.39,53
Studies examining fulfilment of expectations either asked patients how many expectations were fulfilled,20,25,32
or simply examined whether their expectations were ful-filled (yes/no).24,32,34,37,40,41 Even though in the majority of
studies examining fulfilment of expectations patients were also asked about their preoperative expectations prospec-tively (9/14), 13 of the 14 fulfilment studies (93%) did not compare preoperative expectations with postoperative fulfilment. In only one study patients were told what expectations they had cited before and asked how they were now fulfilled.34
Satisfaction
Satisfaction with outcome was mostly examined with one question assessing overall satisfaction or satisfaction with the results of surgery (11 studies). Four studies asked ques-tions about satisfaction with results of surgery, pain relief, and success of operation in increasing home/yard and rec-reational activities (i.e. the Patient Satisfaction Scale).18
Others focused on, for example, likelihood of recommen-dation of surgery, the willingness to have surgery again and a rating of the hospital as a measure of satisfaction with outcome. Four studies assessed satisfaction with: a rating of the results of surgery34 or asked patients the
ques-tion ‘If you were to spend the rest of your life with your hip symptoms just the way they have been in the last twenty-four hours, how would you feel?’.25,41,54 Percentages are
reported for the dichotomized proportion of patients that is classified as being satisfied with the results of surgery as compared to the proportion of patients that is classified as being dissatisfied with the results of surgery (Table 2).
Methodical quality
Initially, scores on 12 items (6%) differed between the two reviewers. Disagreement was dissolved by consensus. The mean quality score was 6 out of 9 (range 4–9) (Table 3). A common methodological flaw was the lack of control for important demographic or clinical factors, or other impor-tant correlates of satisfaction. Other methodological short-comings were the lack of description of number of patients who were lost to follow-up, or too large a number of patients (i.e. > 20%) lost to follow-up, and the absence of a description or operationalization of satisfaction.
Expectations and satisfaction
Overall, 17 out of 22 (77%) studies found a significant positive relationship between preoperative expectations or fulfilment of expectations and satisfaction (Table 4, Fig. 2, Fig. 3). Moreover, 13 out of the 14 studies assessing
fulfilment of expectations reported a significant association
with satisfaction (93%) (Fig. 2, Fig. 3). As such, according to our best-evidence synthesis, strong evidence was found that fulfilled expectations were positively related to satisfaction after surgery. Only four out of eight studies examining preoperative expectations reported a signifi-cant association with satisfaction (50%) (Fig. 2, Fig. 3). Therefore, according to the guidelines, conflicting evi-dence was found for a positive link between preoperative expectations and satisfaction.
Difference between TKA and THA patients
similar significant positive link between fulfilled expecta-tions and satisfaction existed.34
Of the 14 fulfilment studies, eight (57%) reported val-ues regarding fulfilment of expectations. Almost all hip (81%) and knee (77%) patients had all their expectations fulfilled at least six months post-surgery. On average, all expectations were fulfilled in hip patients in 79%, and in knee patients in 63%. Ninety-one per cent of the hip patients were satisfied with the outcome of surgery, while knee patients were satisfied with the outcomes of surgery in 86% of cases.
Retrospective versus prospective designs
Of the eight preoperative studies, seven studies (88%) pro-spectively assessed expectations before surgery. Only one study adopted a retrospective design in which patients were asked, after surgery, to recall their preoperative expectations.33 Three out of seven studies (43%) which
prospectively assessed preoperative expectations reported a significant positive association between expectations and satisfaction (Table 4). The one study examining pre-operative expectations after surgery (i.e. retrospectively) also reported a significant positive relationship with satis-faction.33 As such, according to the best-evidence synthesis,
conflicting findings are reported as to whether preopera-tive expectations are related to satisfaction in a prospec-tive design. Moreover, limited evidence existed for the relationship between preoperative expectations and satis-faction in a retrospective design.
Comparing differences in follow-up period
Most studies adopted a follow-up period of approximately one year (68%). The significance of the relationship between (fulfilment of) expectations and satisfaction var-ied largely between different follow-up times and did not point towards a fixed optimal follow-up period (Table 5). Therefore, limited evidence existed for the notion that ful-filment of expectations leads to satisfaction up to six months after surgery. However, strong evidence existed for up to one year after surgery, conflicting evidence for up to two years and strong evidence for up to six years.
Discussion
This best-evidence synthesis provides an overview of the literature regarding the relationship between (fulfilment of) outcome expectations and satisfaction with outcome, and the influence of used methodology and patient group on the (existence of the) relationship. Almost all studies assessing fulfilment of expectations reported a significant positive association with either level of satisfaction or the odds of being satisfied with the results of surgery (93%). In contrast, only half of the studies reported a significant relationship between preoperative expectations and satis-faction with outcomes of surgery.
One cross-sectional study found that preoperative expectations were generally related to a high level of satis-faction when assessing expectations retrospectively. None-theless, they did not state whether either low or high
Table 3. Quality assessment with Newcastle-Ottawa Scale.
Author, year Selection Comparability Outcome Total Quality Anakwe et al, 201112 • • • • • • • 7 / 9 High
Arden et al, 201136 • • • • • • • 7 / 9 High
Bourne et al, 201011 • • • • • • • 7 / 9 High
Clement et al, 201540 • • • • • • 6 / 9 High
Eisler et al, 200237 • • • • • • 6 / 9 High
Gandhi et al, 200942 • • • • 4 / 9 Moderate
Hamilton et al, 201310 • • • • • • 6 / 9 High
Jain et al, 201720 • • • • • • • • 8 / 9 High
Jain et al, 201719 • • • • • • • 7 / 9 High
Kiran et al, 201538 • • • • • • 6 / 9 High
Lim et al, 201534 • • • • • • 6 / 9 High
Lingard et al, 200621 • • • • • • • 7 / 9 High
Mancuso et al, 199733 • • • • • • 6 / 9 High
Mancuso et al, 200941 • • • • 4 / 9 Moderate
Mannion et al, 200924 • • • • • • 6 / 9 High
Noble et al, 200626 • • • • • • 6 / 9 High
Palazzo et al, 201425 • • • • • • 6 / 9 High
Scott et al, 201022 • • • • • • • 7 / 9 High
Scott et al, 201232 • • • • • 5 / 9 Moderate
Gonzalez Saenz de Tejada
et al, 201454 • • • • • • 6 / 9 High
Thambiah et al, 201528 • • • • • • 6 / 9 High
Vissers et al, 201035 • • • • • • • 7 / 9 High
Note. Each study could score a maximum of nine points in total (i.e. four points for selection, two points for comparability and three points for exposure/outcome).
Table 4. Conclusions about relationship between expectations and satisfaction of included studies.
Author, year Sig. Conclusions Statistics
Anakwe et al, 201112 Yes A significant positive correlation between fulfilment of expectations and
overall satisfaction r = .65, p ≤ .001 Arden et al, 201136 No Preoperative expectations did not influence level of satisfaction at 12 months
or 24 months post surgery p = .17p = .96 Bourne et al, 201011 Yes Univariate statistical analysis showed that a significant difference existed
between patients with met and unmet expectations in terms of satisfaction OR = 10.7, p ≤ .001 Clement et al, 201540 Yes 16 of 17 met expectations were significantly associated with higher
satisfaction OR ≥ 7.9, p ≤ .08
Eisler et al, 200237 Yes Fulfilled expectations about pain and walking ability were moderately
positively correlated with satisfaction r = .47r = .46
Gandhi et al, 200942 No No differences in satisfaction were found between patients with high,
moderate or low expectations p = .92p = .62 p = .28 Hamilton et al, 201310 Yes Meeting patient expectations was significantly positively correlated with
higher satisfaction r = .74, p ≤ .001 Jain et al, 201720 Yes Preoperative expectations were positively associated with higher satisfaction
at six months b = .17, p ≤.001
Jain et al, 201719 Yes More fulfilment of expectations is related to higher satisfaction r2 = .29, p ≤ .001
Kiran et al, 201538 No Preoperative expectations did not correlate with satisfaction n/a
Lim et al, 201534 Yes At two-year follow-up, met expectations were significantly associated with
satisfaction OR = 105.3, p ≤ .001 Lingard et al, 200621 No Satisfaction was not associated with level of preoperative expectations n/a
Mancuso et al, 199733 Yes A strong positive correlation was found between preoperative expectations
and satisfaction n/a
Mancuso et al, 200941 Yes Patients who had a favourable response had a greater proportion of
expectations fulfilled (90%) in comparison with those who did not have a
favourable response (39%)
p ≤ .001 Mannion et al, 200924 No Expectations or met expectations did not contribute to the explained variance
in satisfaction n/a
Noble et al, 200626 Yes Met expectations was, among five other variables, a significant contributor
to satisfaction OR = 6.01, p ≤ .001 Palazzo et al, 201425 Yes Fulfilment of expectations was associated with satisfaction OR = 1.08, p ≤ .001
Scott et al, 201022 Yes Satisfaction correlated significantly with met expectation r = .77
Scott et al, 201232 Yes A significant difference was found between met expectations in terms of
satisfaction in THA patients and TKA patients p = .003p ≤ .001 Gonzalez Saenz de
Tejada et al, 201454 Yes High and very high expectations of daily activities were associated with a higher level of satisfaction p = .012p ≤ .001
Thambiah et al, 201528 Yes Preoperative expectations were significantly associated with higher
satisfaction p = .033
Vissers et al, 201035 Yes Fulfilled expectations regarding limitations and overall success of treatment
were significantly related to satisfaction (p ≤ .001) OR = 13.6, p ≤ .001OR = 34.0, p ≤ .001
Expectations (17/22) Preoperative expectations (4/8) Prospective (3/7) Retrospective (1/1) Fulfilled expectations (13/14)
TKA (1/3) combined (1/2)TKA/THA separated (0/0)TKA/THA THA (2/3) TKA (7/8) combined (1/1)TKA/THA separated (2/2)TKA/THA THA (3/3)
Fig. 2 Schematic representation of methodological characteristics of included studies and number of studies reporting a significant
correlation between (fulfilment of) preoperative expectations and satisfaction.
expectations, or having expectations in general, was related to satisfaction.33 Thereby, it seems that the findings
regarding the relationship between preoperative expecta-tions and satisfaction become more conflicted when assessing the relationship prospectively. Some patients
might not be able to recall their preoperative expectations after surgery as the amount of time between the actual expectation and the recall of this expectation, as well as the meaningfulness of the expectation for the patient, deter-mines the accuracy of the recall.55 Patients may even Table 5. Percentage of studies with a significant relationship between (fulfilled) expectations and satisfaction found across studies, stratified for follow-up period.
Relationship Yes (percentage) No (percentage) Total (22)
Up to six months 2 (100%) 0 (0%) 2 Fulfilment 1 (50%) 0 (0%) Preoperative expectations 1 (50%) 0 (0%) Up to one year 10 (80%) 2 (20%) 12 Fulfilment 9 (100%) 0 (0%) Preoperative expectations 1 (25%) 2 (75%) Up to two years 3 (50%) 3 (50%) 6 Fulfilment 2 (67%) 1 (33%) Preoperative expectations 1 (33%) 2 (67%) Up to six years 2 (100%) 0 (0%) 2 Fulfilment 1 (100%) 0 (0%) Preoperative expectations 1 (100%) 0 (0%) 6 24 7 7 6 6 6 6 4 5 7 7 7 6 6 35 19 37 25 26 40 41 32 12 22 11 34 10 7 7 6 38 21 36 42 4 Neutral impact Negative impact Preoperative expectations Fulfilment of expectations Positive impact 6 6 8 20 33 28 6 54
Fig. 3 Harvest plot: evidence for relationship between (fulfilment of) preoperative expectations and satisfaction, stratified by study
design.
Note. Columns represent studies included in this systematic review with their reference number below. The height of columns corresponds to the number of
experience some sort of recall bias or response shift. Due to this possible response shift, patients change their views about expectations to match their present status.43 In fact,
it is found that about 35% of all patients recalled their pre-operative function as higher or lower than the actual level of functioning.56
The expectation-confirmation theory states that dis-confirmation or dissatisfaction results from a lack of bal-ance between expectations and fulfilled expectations.57
Patients might therefore (unconsciously) change their preoperative expectations postoperatively in order to diminish imbalance between expectations and outcomes and to prevent dissatisfaction. Consequently, both high and low expectations could in essence lead to satisfac-tion when these expectasatisfac-tions are fulfilled.58,59 However,
it can be noted that high expectations have an advantage over low expectations. It was proposed that patients with realistic high expectations might be more motivated to obtain the desired results in rehabilitation by adhering to instructions and training,54 and might actually achieve
these results through some sort of self-fulfilling proph-ecy60 resulting in fulfilled expectations, leading to a high
level of satisfaction. Moreover, as Eisler et al stated: ‘The motivation to undergo surgery reflects its reward value and the expectation of success’.37 It is therefore of great
importance to create and maintain high expectations, considering that a delay, or even refusal of surgery may result from low expectations. Nevertheless, unrealistic high expectations (i.e. high expectations which are not in accordance with actual expected outcomes) could in turn lead to dissatisfaction and lower health-related qual-ity of life61 and, unfortunately, up to half of the patients
have too optimistic expectations.24,26 Summarizing the
results of this systematic review, thereby taking into account the existing evidence regarding expectations in TKA and THA patients, it should be noted that patients should have high expectations in order to achieve opti-mal results, yet should be guarded from unrealistic high or low expectations, as they could lead to unfulfilled expectations and consequently to dissatisfaction.
The contradictory findings from studying only the effect of preoperative expectations on satisfaction were absent when fulfilment of expectations was studied ins-tead. Almost all studies in which the relationship between fulfilment of expectations and satisfaction was exam-ined, found a significant relationship. Only one study told patients what expectations they had cited before and asked how they were now fulfilled.34 This study was
the only study which found no relationship between ful-filment and satisfaction. Even though it was previously found that a possible response shift could not interfere with the significance of the relationship between fulfilled
expectations and satisfaction,46 future research should
examine the effects between recalled and actual fulfilled expectations on satisfaction.
The results in this review differ largely between up times and do not point towards a fixed optimal follow-up period. As Barlow et al46 pointed out, a form of timing
bias could exist, as expectations may not be fulfilled up to two years after surgery, considering that function could progress up to two years after surgery. Furthermore, no large differences were found in terms of fulfilled expecta-tions or percentage of satisfied patients when differenti-ating between hip and knee patients. In other studies, THA patients generally met more expectations and were more satisfied with the outcome than TKA patients.45
It seems that these patients returned to function to a larger and faster extent than TKA patients.4,8,45 Therefore,
expectations might be met at an earlier stage. Nonethe-less, after six months, improvement in function retur-ned to the same level for both patient groups.4 The return
to the same level of improvement between hip and knee patients, which is found after six months, could explain why, in our review, fulfilled expectations and satisfac-tion rates are no different between hip and knee patients, as the majority of studies examined fulfilled expecta-tions beyond six months post surgery. However, consid-ering that there are differences between hip and knee patients, future research should examine whether the optimal level of expectations also differs between hip and knee patients.
This study has a number of limitations. The defini-tion of ‘satisfacdefini-tion with outcome’ might be a subject of debate since satisfaction is assessed with different instru-ments in the literature. Moreover, the operationalization of outcome expectations was quite diverse as well. Some studies do not report the method of assessment, while others thoroughly examined several domains of expecta-tions (e.g. expectaexpecta-tions regarding symptoms, pain, mobil-ity, quality of life) and satisfaction (e.g. pain, function, hospital experience, and performing regular activities/ sport). The lack of consensus on the operationalization of constructs may be a reason for contradictory findings in preoperative studies. Nonetheless, this explanation for contradictory findings seems unlikely, as there were no conflicting findings in fulfilment studies, while they also differed in operationalization of the constructs. The relationship between fulfilled expectations and satisfac-tion with outcome seems robust, despite differences in measurement and operationalization of the constructs. Another limitation might be the inclusion of a study with revision surgery.37 Although the main objective of that
could have influenced the level of exp ectations. In addi-tion, only statements regarding the significance of the relationships could be made and not regarding the strength or impact of the relationship, as we were unable to extract effect sizes.
In conclusion, fulfilment of expectations is consistently associated with satisfaction regardless of study design or patient group (i.e. hip or knee patients). Emphasis in future research should be placed on the operationaliza-tion and measurement of expectaoperationaliza-tions and satisfacoperationaliza-tion to determine the (strength of the) influence of these differ-ent forms of assessmdiffer-ent on the (existence of the) relation-ship between (fulfilled) expectations and satisfaction with outcome. It should be examined what the optimal level of expectations would, or could, be and how changes in (fulfilled) expectations relate to changes in satisfaction. Furthermore, research should be broadened to other patient groups as well to examine the generalizability of these results to ‘the patient’ in general.
Acknowledgements
We thank Maria Karabatzakis for her contribution in the quality assessment.
IcmJe conflIct of Interest stAtement
TG reports board membership of Nederlandse Orthopaedische Vereniging, outside the submitted work.
The other authors declare no conflict of interest relevant to this work.
fundIng stAtement
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
lIcence
©2020 The author(s)
This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/ licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribu-tion of the work without further permission provided the original work is attributed.
references
1. corti mc, rigon c. Epidemiology of osteoarthritis: prevalence, risk factors and
functional impact. Aging Clin Exp Res 2003;15:359–363.
2. lawrence rc, felson dt, Helmick cg, et al; national Arthritis data workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the
United States. Part II. Arthritis Rheum 2008;58:26–35.
3. Arden n, nevitt mc. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol
2006;20:3–25.
4. Hamilton d, Henderson gr, gaston P, macdonald d, Howie c, simpson AHr. Comparative outcomes of total hip and knee arthroplasty: a prospective cohort study. Postgrad Med J 2012;88:627–631.
5. katz Jn. Total joint replacement in osteoarthritis. Best Pract Res Clin Rheumatol
2006;20:145–153.
6. lützner J, Hübel u, kirschner s, günther kP, krummenauer f. [Long-term
results in total knee arthroplasty: a meta-analysis of revision rates and functional outcome].
Chirurg 2011;82:618–624.
7. söderman P, malchau H, Herberts P, Zügner r, regnér H, garellick g.
Outcome after total hip arthroplasty: Part II. Disease-specific follow-up and the Swedish National Total Hip Arthroplasty Register. Acta Orthop Scand 2001;72:113–119.
8. ethgen o, Bruyère o, richy f, dardennes c, reginster JY. Health-related
quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Joint Surg Am 2004;86:963–974.
9. Berry dJ, Harmsen ws, cabanela me, morrey Bf. Twenty-five-year
survivorship of two thousand consecutive primary Charnley total hip replacements: factors affecting survivorship of acetabular and femoral components. J Bone Joint Surg Am 2002;84:171–177.
10. Hamilton df, lane JV, gaston P, et al. What determines patient satisfaction
with surgery? A prospective cohort study of 4709 patients following total joint replacement.
BMJ Open 2013;3:e002525.
11. Bourne rB, chesworth Bm, davis Am, mahomed nn, charron kd. Patient
satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat
Res 2010;468:57–63.
12. Anakwe re, Jenkins PJ, moran m. Predicting dissatisfaction after total hip
arthroplasty: a study of 850 patients. J Arthroplasty 2011;26:209–213.
13. khatib Y, madan A, naylor Jm, Harris IA. Do psychological factors predict
poor outcome in patients undergoing TKA? A systematic review. Clin Orthop Relat Res 2015;473:2630–2638.
14. Polkowski gg II, ruh el, Barrack tn, nunley rm, Barrack rl. Is pain and
dissatisfaction after TKA related to early-grade preoperative osteoarthritis? Clin Orthop Relat
Res 2013;471:162–168.
15. ware Je Jr, snyder mk, wright wr, davies Ar. Defining and measuring
patient satisfaction with medical care. Eval Program Plann 1983;6:247–263.
16. lochman Je. Factors related to patients’ satisfaction with their medical care. J Community Health 1983;9:91–109.
17. Baumann c, rat Ac, osnowycz g, et al. Do clinical presentation and
pre-operative quality of life predict satisfaction with care after total hip or knee replacement?
J Bone Joint Surg Br 2006;88:366–373.
AutHor InformAtIon
1Department of Medical and Clinical Psychology, Tilburg University, Tilburg,
Netherlands
2Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg
University, Tilburg, Netherlands
3Department of Orthopedics, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands 4Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg,
Netherlands
18. mahomed n, sledge c, daltroy l, fossel A, katz J. Self-administered Patient
Satisfaction Scale for joint replacement arthroplasty. J Bone Joint Surg Br 1998;80:9.
19. Jain d, Bendich I, nguyen ll, et al. Do patient expectations influence
patient-reported outcomes and satisfaction in total hip arthroplasty? A prospective, multicenter study. J Arthroplasty 2017;32:3322–3327.
20. Jain d, nguyen ll, Bendich I, et al. Higher patient expectations predict
higher patient-reported outcomes, but not satisfaction, in total knee arthroplasty patients: a prospective multicenter study. J Arthroplasty 2017;32:S166–S170.
21. lingard eA, sledge cB, learmonth Id; kinemax outcomes group. Patient
expectations regarding total knee arthroplasty: differences among the United States, United Kingdom, and Australia. J Bone Joint Surg Am 2006;88:1201–1207.
22. scott ce, Howie cr, macdonald d, Biant lc. Predicting dissatisfaction
following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 2010;92:1253–1258.
23. Baker Pn, van der meulen JH, lewsey J, gregg PJ; national Joint registry for england and wales; data from the national Joint registry for england and wales. The role of pain and function in determining patient satisfaction
after total knee replacement. J Bone Joint Surg Br 2007;89:893–900.
24. mannion Af, kämpfen s, munzinger u, kramers-de Quervain I. The role
of patient expectations in predicting outcome after total knee arthroplasty. Arthritis Res Ther 2009;11:R139.
25. Palazzo c, Jourdan c, descamps s, et al. Determinants of satisfaction 1 year
after total hip arthroplasty: the role of expectations fulfilment. BMC Musculoskelet Disord 2014;15:53.
26. noble Pc, conditt mA, cook kf, mathis kB. The John Insall Award: patient
expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res 2006;452:35–43.
27. Quintana Jm, escobar A, Aguirre u, lafuente I, Arenaza Jc. Predictors
of health-related quality-of-life change after total hip arthroplasty. Clin Orthop Relat Res 2009;467:2886–2894.
28. thambiah md, nathan s, seow BZ, liang s, lingaraj k. Patient satisfaction
after total knee arthroplasty: an Asian perspective. Singapore Med J 2015;56:259–263.
29. crow r, gage H, Hampson s, Hart J, kimber A, thomas H. The role of
expectancies in the placebo effect and their use in the delivery of health care: a systematic review. Health Technol Assess 1999;3:1–96.
30. uhlmann rf, Inui ts, carter wB. Patient requests and expectations: definitions
and clinical applications. Med Care 1984;22:681–685.
31. Haanstra tm, van den Berg t, ostelo rw, et al. Systematic review: do patient
expectations influence treatment outcomes in total knee and total hip arthroplasty? Health
Qual Life Outcomes 2012;10:152.
32. scott ceH, Bugler ke, clement nd, macdonald d, Howie cr, Biant lc. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg Br 2012;94:
974–981.
33. mancuso cA, salvati eA, Johanson nA, Peterson mg, charlson me.
Patients’ expectations and satisfaction with total hip arthroplasty. J Arthroplasty 1997;12:387–396.
34. lim JB, chou Ac, Yeo w, et al. Comparison of patient quality of life scores and
satisfaction after common orthopedic surgical interventions. Eur J Orthop Surg Traumatol 2015;25:1007–1012.
35. Vissers mm, de groot IB, reijman m, Bussmann JB, stam HJ, Verhaar JA. Functional capacity and actual daily activity do not contribute to patient satisfaction after
total knee arthroplasty. BMC Musculoskelet Disord 2010;11:121.
36. Arden nk, kiran A, Judge A, et al. What is a good patient reported outcome after
total hip replacement? Osteoarthritis Cartilage 2011;19:155–162.
37. eisler t, svensson o, tengström A, elmstedt e. Patient expectation and
satisfaction in revision total hip arthroplasty. J Arthroplasty 2002;17:457–462.
38. kiran A, Bottomley n, Biant lc, et al. Variations in good patient reported
outcomes after total knee arthroplasty. J Arthroplasty 2015;30:1364–1371.
39. mancuso cA, sculco tP, wickiewicz tl, et al. Patients’ expectations of knee
surgery. J Bone Joint Surg Am 2001;83:1005–1012.
40. clement nd, macdonald d, Patton Jt, Burnett r. Post-operative Oxford
knee score can be used to indicate whether patient expectations have been achieved after primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015;23:1578–1590.
41. mancuso cA, Jout J, salvati eA, sculco tP. Fulfillment of patients’ expectations
for total hip arthroplasty. J Bone Joint Surg Am 2009;91:2073–2078.
42. gandhi r, davey Jr, mahomed n. Patient expectations predict greater pain relief
with joint arthroplasty. J Arthroplasty 2009;24:716–721.
43. schwartz ce, Andresen em, nosek mA, krahn gl; rrtc expert Panel on Health status measurement. Response shift theory: important implications for
measuring quality of life in people with disability. Arch Phys Med Rehabil 2007;88:529–536.
44. culliton se, Bryant dm, overend tJ, macdonald sJ, chesworth Bm. The
relationship between expectations and satisfaction in patients undergoing primary total knee arthroplasty. J Arthroplasty 2012;27:490–492.
45. Bourne rB, chesworth B, davis A, mahomed n, charron k. Comparing
patient outcomes after THA and TKA: is there a difference? Clin Orthop Relat Res 2010;468:542–546.
46. Barlow t, clark t, dunbar m, metcalfe A, griffin d. The effect of expectation
on satisfaction in total knee replacements: a systematic review. Springerplus 2016;5:167.
47. waljee J, mcglinn eP, sears ed, chung kc. Patient expectations and
patient-reported outcomes in surgery: a systematic review. Surgery 2014;155:799–808.
48. gunaratne r, Pratt dn, Banda J, fick dP, khan rJk, robertson Bw.
Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature.
J Arthroplasty 2017;32:3854–3860.
49. duivenvoorden t, Verburg H, Verhaar JA, Bierma-Zeinstra sm, reijman m. [Patient expectations and satisfaction concerning total knee arthroplasty]. Ned Tijdschr Geneeskd 2017;160:D534.
50. wells gA, shea B, o’connell d, Peterson JeA, welch V, losos m, et al. The
Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (date last accessed 30 December 2016).
51. slavin re. Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol 1995;48:9–18.
52. lievense Am, Bierma-Zeinstra sm, Verhagen AP, Verhaar JA, koes Bw.
Prognostic factors of progress of hip osteoarthritis: a systematic review. Arthritis Rheum 2002;47:556–562.
53. mancuso cA, sculco tP, salvati eA. Patients with poor preoperative functional
54. gonzalez saenz de tejada m, escobar A, Bilbao A, et al. A prospective
study of the association of patient expectations with changes in health-related quality of life outcomes, following total joint replacement. BMC Musculoskelet Disord 2014;15:248.
55. coughlin ss. Recall bias in epidemiologic studies. J Clin Epidemiol 1990;43:87–91. 56. razmjou H, Yee A, ford m, finkelstein JA. Response shift in outcome
assessment in patients undergoing total knee arthroplasty. J Bone Joint Surg Am 2006;88:2590–2595.
57. Appleton-knapp sl, krentler kA. Measuring student expectations and their
effects on satisfaction: the importance of managing student expectations. J Mark Educ 2006;28:254–264.
58. Hudak Pl, Hogg-Johnson s, Bombardier c, mckeever Pd, wright Jg. Testing a new theory of patient satisfaction with treatment outcome. Med Care
2004;42:726–739.
59. Younger As, wing kJ, glazebrook m, et al. Patient expectation and satisfaction
as measures of operative outcome in end-stage ankle arthritis: a prospective cohort study of total ankle replacement versus ankle fusion. Foot Ankle Int 2015;36:123–134.
60. Andrykowski mA, Brady mJ, greiner cB, et al. ‘Returning to normal’ following
bone marrow transplantation: outcomes, expectations and informed consent. Bone Marrow
Transplant 1995;15:573–581.
